Stent customization system and method

ABSTRACT

Methods and systems are described for receiving a parameter relating to a specific patient, and for customizing one or more attributes of a stent ex situ as an at-least-roughly contemporaneous response to receiving the parameter relating to the specific patient or for customizing one or more junctions of a stent ex situ in response to the received parameter relating to the specific patient.

RELATED APPLICATIONS

For purposes of the USPTO extra-statutory requirements, the presentapplication constitutes a continuation-in-part of U.S. patentapplication Ser. No. 11/455,010, entitled STENT CUSTOMIZATION SYSTEM ANDMETHOD, naming Edward K. Y. Jung, Robert Langer, Eric C. Leuthardt,Royce A. Levien, Robert W. Lord, Mark A. Malamud, John D. Rinaldo, Jr.,Clarence T. Tegreene and Lowell L. Wood, Jr. as inventors, filed 16 Jun.2006, which is currently co-pending, or is an application of which acurrently co-pending application is entitled to the benefit of thefiling date.

The United States Patent Office (USPTO) has published a notice to theeffect that the USPTO's computer programs require that patent applicantsreference both a serial number and indicate whether an application is acontinuation or continuation-in-part. Stephen G. Kunin, Benefit ofPrior-Filed Application, USPTO Official Gazette Mar. 18, 2003, availableat http://www.uspto.gov/web/offices/com/sol/og/2003/week11/patbene.htm.The present Applicant entity has provided above a specific reference tothe application(s) from which priority is being claimed as recited bystatute. Applicant entity understands that the statute is unambiguous inits specific reference language and does not require either a serialnumber or any characterization, such as “continuation” or“continuation-in-part,” for claiming priority to U.S. patentapplications. Notwithstanding the foregoing, Applicant entityunderstands that the USPTO's computer programs have certain data entryrequirements, and hence Applicant entity is designating the presentapplication as a continuation-in-part of its parent applications as setforth above, but expressly points out that such designations are not tobe construed in any way as any type of commentary and/or admission as towhether or not the present application contains any new matter inaddition to the matter of its parent application(s).

All subject matter of the Related Applications and of any and allparent, grandparent, great-grandparent, etc. applications of the RelatedApplications is incorporated herein by reference to the extent suchsubject matter is not inconsistent herewith.

SUMMARY

An embodiment provides a method. In one implementation, the methodincludes but is not limited to receiving a parameter relating to aspecific patient and customizing one or more attributes of a stent exsitu as an at-least-roughly contemporaneous response to receiving theparameter relating to the specific patient. In addition to theforegoing, other method aspects are described in the claims, drawings,and text forming a part of the present disclosure.

In one or more various aspects, related systems include but are notlimited to circuitry and/or programming for effecting theherein-referenced method aspects; the circuitry and/or programming canbe virtually any combination of hardware, software, and/or firmwareconfigured to effect the herein-referenced method aspects depending uponthe design choices of the system designer.

An embodiment provides a system. In one implementation, the systemincludes but is not limited to circuitry for receiving a parameterrelating to a specific patient and circuitry for customizing one or moreattributes of a stent ex situ as an at-least-roughly contemporaneousresponse to receiving the parameter relating to the specific patient. Inaddition to the foregoing, other system aspects are described in theclaims, drawings, and text forming a part of the present disclosure.

An embodiment provides a method. In one implementation, the methodincludes but is not limited to receiving a parameter relating to aspecific patient and customizing one or more junctions of a stent exsitu in response to the received parameter relating to the specificpatient. In addition to the foregoing, other method aspects aredescribed in the claims, drawings, and text forming a part of thepresent disclosure.

In one or more various aspects, related systems include but are notlimited to circuitry and/or programming for effecting theherein-referenced method aspects; the circuitry and/or programming canbe virtually any combination of hardware, software, and/or firmwareconfigured to effect the herein-referenced method aspects depending uponthe design choices of the system designer.

An embodiment provides a system. In one implementation, the systemincludes but is not limited to circuitry for receiving a parameterrelating to a specific patient and circuitry for customizing one or morejunctions of a stent ex situ in response to the received parameterrelating to the specific patient. In addition to the foregoing, othersystem aspects are described in the claims, drawings, and text forming apart of the present disclosure.

In addition to the foregoing, various other embodiments are set forthand described in the text (e.g., claims and/or detailed description)and/or drawings of the present description.

The foregoing summary is illustrative only and is not intended to be inany way limiting. In addition to the illustrative aspects, embodiments,and features described above, further aspects, embodiments, and featureswill become apparent by reference to the drawings and the followingdetailed description.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts an exemplary environment in which one or moretechnologies may be implemented.

FIG. 2 depicts a high-level logic flow of an operational process.

FIG. 3 depicts a high-level logic flow of another operational process.

FIGS. 4-5 each depict exemplary environments in which one or moretechnologies may be implemented.jonathan

FIG. 6 depicts a high-level logic flow of another operational process.

FIG. 7 depicts a high-level logic flow of another operational process.

FIG. 8 depicts a high-level logic flow of another operational process.

FIG. 9 depicts a stent component in which one or more technologies maybe implemented.

FIG. 10 depicts a stent including the component of FIG. 9.

FIG. 11 depicts a stenting site in which one or more technologies may beimplemented.

FIGS. 12-14 each depict another view of the stenting site of FIG. 11.

FIG. 15 depicts a system in which one or more technologies may beimplemented.

FIG. 16 depicts another system in which one or more technologies may beimplemented.

FIG. 17 depicts another stenting site in which one or more technologiesmay be implemented.

FIGS. 18-19 each depict another view of the stenting site of FIG. 17.

FIG. 20 depicts another stenting site in which one or more technologiesmay be implemented.

FIG. 21 depicts another view of the stenting site of FIG. 20.

FIG. 22 depicts another stenting site in which one or more technologiesmay be implemented.

FIGS. 23-25 each depict another view of the stenting site of FIG. 22.

FIG. 26 depicts a stent component in which one or more technologies maybe implemented.

FIG. 27 depicts a profile relating to the stent component of FIG. 26.

FIG. 28 depicts a stent component in which one or more technologies maybe implemented.

FIG. 29 depicts a profile relating to the stent component of FIG. 28.

FIGS. 30-33 depict variants of the flow of FIG. 2.

FIG. 34 depicts variants of the flow of FIG. 3.

FIGS. 35-37 depict variants of the flow of FIG. 6.

FIG. 38 depicts variants of the flow of FIG. 7.

FIG. 39 depicts variants of the flow of FIG. 8.

FIG. 40 depicts another system in which one or more technologies may beimplemented.

FIGS. 41-42 depict additional variants of the flow of FIG. 3.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of the subject matterpresented here.

Referring now to FIG. 1, there is shown an exemplary environment inwhich one or more technologies may be implemented. As shown system 100comprises receiver 130 and processing module 180 operatively coupled bylinkage 109. Receiver 130 may include one or more of user interface 132(e.g. with output device 133 or input device 134), network interface 135(e.g. in communication with a network, not shown), one or moreparameters 136, control module 138 operably configured to controlprocessing module 180 via port 139. Processing module 180 may includeone or more of inventory 141, custom processor 160 (optionally withnetwork interface 161), data 181 (optionally including tables 182), andvessel 105 (optionally containing stent 106).

Referring now to FIG. 2, there is shown a high-level logic flow 200 ofan operational process. Operation 210 describes receiving a parameterrelating to a specific patient (e.g. receiver 130 receiving one or moreof a patient identifier, a patient attribute, a customized stentfeature, a handle for obtaining patient information, or the like). Insome embodiments, the relation can be revealed or otherwise madeaccessible by a patient, healthcare provider or other user.

Operation 220 describes customizing one or more attributes of a stent exsitu as an at-least-roughly contemporaneous response to receiving theparameter relating to the specific patient (e.g. processing module 180making or adapting the stent directly or by proxy within about a monthof obtaining the parameter from the specific patient). In someembodiments, a customization or adaptation event can be roughlycontemporaneous with receiving a parameter if soon enough so that asubstantial physiological change bearing upon the event is unlikely orunexpected. This can encompass as much as a few months or as little as aday in some instances, depending on the patient and the circumstances.Those skilled in the art will recognize, however, that customization oradaptation systems and methods described herein that can take only a fewminutes, or sometimes less, which can be especially useful foraddressing an arterial perforation or similar emergency as may ariseduring a surgical procedure.

Referring now to FIG. 3, there is shown a high-level logic flow 300 ofanother operational process. Operation 330 describes receiving aparameter relating to a specific patient (e.g. receiver 130 receivingone or more of a patient identifier, a patient attribute, a customizedstent feature, a handle for obtaining patient information, or the like).In some embodiments, the relation can be revealed or otherwise madeaccessible by a patient, healthcare provider or other user.

Operation 340 describes customizing one or more junctions of a stent exsitu in response to the received parameter relating to the specificpatient (e.g. processing module 180 making or adapting a friction-fit,joint, or adhesion between or along portions of the stent). In someembodiments processing module 180 can be configured to perform one ormore operations of other flows taught herein as well, such as thosetaught in FIGS. 30-39. In some embodiments operation 340 can customize ajunction in component form also, such as by ensuring a proper fitbetween components of a bifurcated stent designed for in situ assembly.

Referring now to FIG. 4, there is shown another exemplary environment inwhich one or more technologies may be implemented. As shown system 400includes receiver 430 including one or more of parametric input 410,local interface 432, network interface 435, control module 438, ormessage parser 450. System 400 optionally couples to one or moreimplementation system (such as processing module 180 or the system ofFIG. 5) via direct linkage 497 or (indirectly) via network linkage 498and network 496. Parametric input 410 includes one or more ofmeasurement input 411 or model input 412. Model input 412 can includeone or more of patient identifier input 413, material identifier input415, dimensional input 416, image input 418, inventory status input 419,component type input 420, or structure type indicator 421. Componenttype input 420 can include one or more of stent type input 425, wiretype input 426, or sheet type input 427. Structure type indicator 421can include one or more of vascular type input 422, digestive type input423, a renal type input (not shown), or some more specific or othercategorical information that may assist in effective customization.Local interface 432 can include one or more of output device 433 orinput device 434. Control module 438 can optionally include one or moreinstances of port 439, each of which may control a processing modulesuch as that of FIG. 5, for example, via direct linkage 497 or networklinkage 498.

Referring now to FIG. 5, there is shown another exemplary environment inwhich one or more technologies may be implemented. As shown system 500includes processing module 580 that can communicate with receiver 430via direct linkage 597 or network linkage 598. Processing module 580 maycontain one or more of custom processor 560, data manager 590, or vessel588 configured for positioning stent 510 or its components duringprocessing as described herein. In some embodiments, custom processor560 can include one or more of network interface 561 (operable tointeract with linkages 597, 598), stock designator 562, modelimplementer 563, applicator controller 564, or plant 570. Applicatorcontroller 564 can optionally include or couple with one or more ofantiproliferative agent dispenser 565, anticoagulant dispenser 567,antibiotic dispenser 568, substance applicator 569, or the like. Plant570 can include one or more of inventory controller 540 or machineinterface 571. In some embodiments, inventory controller 540 can includeor couple with one or more of sheet inventory 541, stent inventory 542,wire inventory 543, frame inventory 545, sleeve inventory 546, orcatheter inventory 547. Machine interface 571 can likewise include orcouple with one or more of scribe controller 572 operable forcontrolling scribe 502, sheet bender controller 573 operable forcontrolling sheet bender 503, sheet stretcher controller 574 operablefor controlling sheet stretcher 504, press controller 575 operable forcontrolling press controller 505, laser controller 578 operable forcontrolling laser 508, or bonder controller 579 operable for controllingbonder 509. Data manager 590 can include one or more of data 581,storage manager 591, or data aggregator 599. Data 581 can include table582 containing several instances of record 585 each associating one ormore identifiers 583 with one or more attributes 584 as well as othertables 586, as described herein. Storage manager 591 can include one ormore of medical history 593 or regimen implementer 594, which canoptionally include dosage profile 595.

Those skilled in the art will recognize that connections among instancesof components of systems 400, 500 can exist transiently in someembodiments. In one scenario stent 510 can be formed from sheetinventory 541, for example, before being transported to another instanceof system 500 at which it is coated by a substance applicator 569 andthen compressed into a custom catheter from catheter inventory 547. Inthis fashion a stent may undergo multiple instances of specialization atvarious processing sites.

Referring now to FIG. 6, there is shown a high-level logic flow 600 ofanother operational process. Operation 610 describes obtaining aparameter relating to a stent inventory shortage (e.g. receiver 130receiving some quantity, cost, size, composition, configuration,distinguishing identifier or feature, or the like, of a just-designedstent or other stent in short supply). In some embodiments informationfrom several inventories accessible to a requester is used inestablishing the stent inventory shortage. Alternatively oradditionally, the parameter can be obtained substantially in lieu ofother indications of the inventory shortage.

Operation 620 describes configuring a stent with a flow occlusionportion in response to the obtained parameter relating to the stentinventory shortage (e.g. processing module 180 configuring the flowocclusion portion or a frame that supports it responsive to graphical orother positional indications describing a stent in short supply).Alternatively or additionally, the obtained parameter can relate tomaterial compositions, physiological contexts, or other attributes asdescribed herein that may correspond with the material or othershortage. In some embodiments an inventory may include only stentcomponents, for example, that can be combined or otherwise configured inany of a very large array of distinct stent designs. Some suchembodiments optionally define no initial inventory of stents with flowocclusion portions, for example, making each stent to order responsiveto parameters that distinctly define each flow occlusion portion.

Referring now to FIG. 7, there is shown a high-level logic flow 700 ofanother operational process. Operation 760 describes receiving aparameter relating to a specific patient (e.g. receiver 130 receivingone or more of a patient identifier, a patient attribute, a customizedstent feature, a handle for obtaining patient information, or the like).In some embodiments, the relation can be revealed or otherwise madeaccessible by a patient, healthcare provider or other user.

Operation 770 describes configuring a stent with a flow occlusionportion in response to receiving the parameter relating to the specificpatient (e.g. processing module 180 forming the flow occlusion portionupon receiving an authorization code from the patient's care facility).In some embodiments, further handshaking occurs in response to receivingthe parameter, for example, an outcome of which triggers the stentconfiguration. Such handshaking can involve, for example, offering apurchaser a choice of catheters in catheter inventory 547.

Referring now to FIG. 8, there is shown a high-level logic flow 800 ofanother operational process. Operation 880 describes obtaining aparameter relating to a stent inventory shortage (e.g. receiver 130receiving some quantity, cost, size, composition, configuration,distinguishing identifier or feature, or the like, of a just-designedstent or other stent in short supply). In some embodiments informationfrom several inventories accessible to a requester is used inestablishing the stent inventory shortage. Alternatively oradditionally, the parameter can be obtained substantially in lieu ofother indications of the inventory shortage (e.g. by parameters 156designating some orders with an “EMERGENCY” status or other parameterindicating an elevated priority.

Operation 890 describes specializing one or more stents in response toobtaining the parameter relating to the stent inventory shortage (e.g.processing module 180 making or adapting several miscellaneous stents toorder after receiving the order from a hospital in its vicinity). Insome embodiments such stents can each be provided compressed within arespective short catheter from catheter inventory 547. In someembodiments, the short catheters can be customized by components ofsystem 500 in various combinations as taught herein, substantially inthe same manner as described with regard to customizing stents.

Referring now to FIG. 9, there is shown an exemplary environment inwhich one or more technologies may be implemented. As shown component900 comprises sheet material 910 in a substantially rectangular formincluding flexible mesh portion 921 (with numerous holes 925) and flowocclusion portion 922. Sheet material 910 can be formed into a stent bywelding, soldering, gluing, or otherwise affixing junction edge 931substantially along junction edge 932.

Referring now to FIG. 10, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown stent1000 comprises sheet material 910 of FIG. 9 rolled into a tube form andbonded as described so that profile 1067 is substantially circular. Insome embodiments, a versatile and cost-effective “stent printer” canreside locally within a surgical, veterinary, or other care facility.Inventories of sheet materials and the like can be fed, positioned, ordispensed to form pleats, mesh configurations of a locally controllabledensity/rigidity, perforations, flow occlusion portions, or the like.Coatings can be formed controllably using toner or inkjet technology,for example, especially for stents with a small number of sheet materialcomponents and few junctions like those of FIGS. 9-19.

Referring now to FIG. 11, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown system1100 comprises a vascular probe with an intravascular portion 1117inside blood vessel 1184 of a subject's vascular system. Intravascularportion 1117 can include hub 1192 comprising one or more ofimaging/control circuitry 1120 or communication circuitry 1150. In someembodiments, system 1100 includes one or more elements as taught in U.S.patent application Ser. No. 11/414,164 (“Imaging via Blood Vessels”),incorporated by reference to the extent not inconsistent herewith. Bloodvessel 1184 is shown in a vicinity of anomaly 1174, with blood 1183 in aflow 1182 through intravascular portion 1117. Anomaly 1174 protrudessomewhat radially from wall 1185 into surrounding tissue 1172. Sensorarray 1121 is arranged about the circumference of intravascular portion1117, including many elements 1128 generally oriented radially. Withballoon 1113 and other deflector 1114 deflated, intravascular portion1117 can easily advance upward using a guidewire until, for example,imaging/control circuitry 1120 can detect anomaly 1174 (via element 1128and conduit 1155, e.g.). As shown, element 1128 has detected anomaly1174 within its field of view 1135.

Referring now to FIG. 12, there is shown system 1100 of FIG. 11 inanother circumstance. Extension 1289 has entered intravascular portion1117, substantially closing port 1299 to flow 1182. In some embodiments,hub 1192 can position extension 1289 in a controlled relation to anomaly1174 by virtue of the imaging from sensor array 1121 and a controlleddegree of axial and rotational position of extension 1289.

Referring now to FIG. 13, there is shown system 1100 of FIG. 11 inanother circumstance. Here, intravascular portion 1117 has been partlywithdrawn (downward as shown) to reveal extension 1289 as a collapsedstent 1350 through which balloon 1352 passes. Stent 1350 is positioneddistally and rotationally so that patch 1322 substantially aligns withanomaly 1174. A remaining surface (e.g. frame 1321) need not be flowocclusive and can be a sheet material mesh, a wire frame, or the like.

Referring now to FIG. 14, there is shown a partly cut away view of stent1350 in system 1100 of FIG. 11. As shown, stent 1350 has been expandedby balloon 1352 so that pleats 1415 are each substantially restored to aflat configuration. As shown, patch 1322 aligns over anomaly 1174,substantially reducing flow adjacent anomaly 1174. This general approachcan be used to reduce a risk that anomaly 1174 will metastasize, cause aleakage of fluid into or out of vessel 1184, or the like.

Referring now to FIG. 15, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown system1500 comprises stent 1550 in collapsed form to highlight the use ofpleats 1551, 1552 to collapse stent 1550. Each of the pleats is alignedgenerally axially along stent 1550, joining successive instances ofsmooth portion 1553 of a sheet material. The effect is so that stent1550 is collapsed to a diameter 1567 while passing through a catheterand then expanded in situ via balloon 1588 to about twice that diameter.

Referring now to FIG. 16, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown system1600 comprises stent 1650 in collapsed form to highlight the use ofsubstantially helical or other curvilinear pleats 1651, 1652 so thatstent 1650 can pass through catheter 1639. As shown stent 1650 has beencollapsed to a diameter 1667 smaller than one-sixth of its expandedcross-sectional diameter. Even so, an inner diameter 1666 has beenmaintained at least about 25% as large as diameter 1667 so that balloon1688 can be urged substantially through stent 1650 before or aftercollapsing stent 1650.

Referring now to FIG. 17, there is shown a heuristic model 1700 of aforked blood vessel comprising a broad-based aneurysm 1720, an inlet1701 and two outlets 1702, 1703. As shown, blood flow passes throughbroad-based aneurysm, creating pressure and a risk of rupture. Moreoverthe large base makes the aneurysm difficult to treat, for example, byordinary techniques such as a Guglielmi Detachable Coil (GDC), which canfall out of a broad-based aneurysm and occlude blood vessels. In someembodiments, models such as heuristic model 1700 can be generated (atleast initially) by angiography or other imaging technology.

Referring now to FIG. 18, there is shown a model of stent 1800customized for the forked blood vessel of FIG. 17. Mesh portion 1821along the top as shown extents from flow inlet 1801 to flow outlet 1802around (oval-shaped) branch outlet 1803. Flow occlusive portion 1822similarly extends along the bottom of stent 1800 from flow inlet 1801 toflow outlet 1802. Taper portion 1875 shows a short interval across whichdiameter of stent 1800 narrows at a perceptible rate (less than 20%, asshown) from a uniform diameter along cylindrical portion 1876. Also asubstantial portion of occlusion site 1820 (configured to occludebroad-based aneurysm 1720) has a thrombogenic surface coated orotherwise formed thereon. (In some embodiments, a thrombogenic surfacecan be one that is more thrombogenic than pure titanium.)

Referring now to FIG. 19, there is depicted a physical environment 1900in which stent 1800 has been implanted. As shown blood flows from inlet1901 to outlet 1902 and to outlet 1903, substantially occluded fromaneurysm 1920. Also GDC coil 1928 has been implanted into aneurysm 1920,promoting clot formation and minimizing further pressure on thedistended tissue of aneurysm 1920.

Referring now to FIG. 20, there is shown a heuristic model 2000 of humanorgans comprising stomach 2072, liver 2047, gallbladder 2093, duodenum2089, and pancreas 2035. As shown, bile duct 2024 is substantiallynarrowed in region 2020, creating a risk blockage. Such blockage caninterfere with the digestion of fats and can potentially cause jaundiceand a variety of other serious problems.

Referring now to FIG. 21, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown system2100 shows a more magnified view 2121 of region 2020 of FIG. 20. Alsostent 2150 has been implanted after being customized, for example, withnominal diameter 2151 and radius of curvature 2152 (to a nominal flowpath center 2156, e.g.) customized to the specific patient's narrowedportion of bile duct 2024. In some embodiments, an ideal size can bedetermined by applying a formula to the patient's size, age, gender,symptoms, or the like. An appropriate stent can then be selected forcases in which an off-the-shelf stent provides a satisfactory fit, orcustomized in other cases.

Referring now to FIG. 22, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown sitemodel 2200 includes and aorta 2267 with a fusiform abdominal aorticaneurysm 2205, as well as kidneys 2280, and iliac artery 2235 forreference. As shown aorta 2267 presents a very challenging stentingsite, in that vital arteries emerge from aneurysm 2205—renal arteries2281, 2282 and mesenteric arteries 2216—that should not be occluded forvery long during implantation. Interruptions in flow to these arteriescan damage kidneys 2280, for example. Moreover a rupture of aneurysm2205 or any flawed stent deployment are serious risks.

In one scenario, site model 2200 is initially received as MRI or similaranatomical data from the specific patient, such as by model implementer563. Model implementer may likewise recognize aneurysm 2205 and presenta default stent model 2210. Alternatively or additionally, a surgeon mayprovide some stent parameters such as locations of flow port 2201, 2202,such as with a pointing device or by providing a stent model name like“Fusiform Abdominal Aortic M” by which stent model 2210 may beretrieved, adapted, or implemented. In some embodiments, renal arteries2281, 2282 and mesenteric arteries 2216 are fitted with short sleeves2231, 2232 as shown, for example, by application of the model or byspecification of the surgeon. Alternatively or additionally, localinterface 432 may permit a surgeon to signal a succession of the“Fusiform Abdominal Aortic” models graphically, which succession may beaccompanied by statistics, supporting literature, components, sources,or the like relating to that model for the surgeon's consideration.

Referring now to FIG. 23, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown modelstent 2300 comprises body 2379 and sleeves 2311, 2312, 2316 customsuited to site model 2200. For deployment it should be considered howthese components can be compresses for passage through, for example,iliac artery 2235 and femoral artery (not shown). Some junctions, suchas that shown in region 2323 between sleeve 2312 and body 2379, can bean important design issue for effective deployment.

Referring now to FIG. 24, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown region2424 shows a magnified view of region 2323 of FIG. 23. Here, invertedsleeve 2412 illustrates one approach to compressing sleeve 2312 forplacement within a catheter (not shown) for a version of stent 2300 thatintegrates sleeve 2312 and body 2379.

Referring now to FIG. 25, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown region2525 shows another magnified view of region 2323 of FIG. 23. Here,annular pleats 2515 illustrate an alternative approach to compressingsleeve 2312 for placement within a catheter. In some embodiments,annular pleats can be expanded in situ as a bellows. For example, aprobe with a guidewire can press through an end of the (initiallyclosed) sleeve 2312 to provide blood flow quickly to kidney 2280 upondeployment. In such a deployment, an imaging system can be used toprevent the guidewire from damaging the aorta 2267 or renal artery 2282.

Referring now to FIG. 26, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown sheetcomponent 2600 includes sheet material 2612 coated with second agent2615 and first agent 2618 each with a controlled thickness and surfacearea.

Referring now to FIG. 27, there is shown an elution profile 2700 bywhich (localized) dosages 2731 are schematically plotted against time2732 in increments 2733 such as days or weeks. As shown, first dosageprofile drops off sharply in the third and fourth time increments,during which time second agent dosage 2702 increases steadily. Thoseskilled in the art will recognize that customizing such drug elutionprofiles by these teachings can be used as an effective alternative orsupplement to systemic regimens that complement the stenting treatment.

Referring now to FIG. 28, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown wirecomponent 2800 includes wire material 2812 coated with second agent 2815and first agent 2818 each with a controlled thickness and surface area.

Referring now to FIG. 29, there is shown an elution profile 2900 bywhich (localized) dosages 2931 are schematically plotted against time2932 in increments 2933 such as days or weeks. As shown, first dosageprofile drops off sharply in the first and second time increments, andsecond agent dosage 2902 increases steadily through the first fourincrements. Those skilled in the art will recognize that customizingsuch drug elution profiles by these teachings can be used as aneffective alternative or supplement to systemic regimens that complementthe stenting treatment.

In some embodiments, first agents 2618, 2818 include one or more of ananticoagulant or antiplatelet and second agents 2615, 2815 include oneor more of an antiproliferative. Alternatively or additionally, firstagents 2618, 2818 can include an antibiotic. Alternatively oradditionally, second agents 2615, 2815 can include a chemotherapytreatment (responsive to an indication of an anomaly that may becancerous, e.g.). In some embodiments, an elutive customization of onestructure is generated in response to an elutive attribute of anotherstructure (e.g. displaying information about an off-the-shelf version ofwire component 2800 before receiving a customized regimen for sheetcomponent 2600).

Referring now to FIG. 30, there are shown several variants of the flow200 of FIG. 2. Operation 210—receiving a parameter relating to aspecific patient—may include one or more of the following operations:3012, 3014, or 3017. Operation 220—customizing one or more attributes ofa stent ex situ as an at-least-roughly contemporaneous response toreceiving the parameter relating to the specific patient—may include oneor more of the following operations: 3021, 3022, 3025, 3026, 3027, 3028,or 3029.

Operation 3012 describes receiving a heuristic model identifier as theparameter relating to the specific patient (e.g. model input 412receiving a filename or record number of a model of a broad-basedaneurysm). The model may call for or utilize parameters such as vesselsize, vessel curvature, vessel elasticity, or the like. In someembodiments such parameters can be provided via image input 418 orprovided or modified by local interface 432. This can occur, forexample, in embodiments in which operation 210 is performed by receiver430 and in which operation 220 is performed by processing module 580.

Operation 3014 describes receiving an identifier of the specific patientwith the parameter relating to the specific patient (e.g. patientidentifier input 413 receiving a patient name or number in a commonrecord or message with one or more parameters that may guide stentcustomization). In some embodiments, the parameter includes a placementssite descriptor such as “intracranial,” “peripheral vascular,”“intraabdominal,” “intrathoracic,” or the like, or a code correspondingwith such a descriptor. Alternatively or additionally the parameter mayinclude or accompany a pathology descriptor such as “AVM” (for anarteriovenous malformation), “fistula,” “stenosis,” “aneurysm,” or thelike, for example, for a vascular stent.

Operation 3017 describes receiving a composite material identifier asthe parameter relating to the specific patient (e.g. material identifierinput 415 identifying nitinol or other titanium-containing alloyrelating to a stent component). Alternatively or additionally, materialidentifier input 415 can identify a second layer such as asilver-containing plating on a sheet material or wire material as thestent component.

Operation 3021 describes selecting a template responsive to theparameter relating to the specific patient (e.g. stock designator 562selecting a sheet material as a thinnest template that is thick enoughor a thickest template that is thin enough). In some instances, aplating, texturing, or other template surface property can affecttemplate selection as well.

Operation 3022 describes customizing the selected template responsive toother information relating to the specific patient (e.g. sheet stretchercontroller 574 stretching at least a portion of the designated stock toobtain a desired thinness with sheet stretcher 504). In some instances,mechanical manipulations of operation 3022 are delayed until a specificinstruction or other confirmatory action from a buyer or user isdetected. Alternatively or additionally, press controller 575 or otherportions of machine interface 571 can perform operation 3022.

Operation 3025 describes customizing a material composition of the stentresponsive to the parameter relating to the specific patient (e.g.applicator controller 564 applying one or more coatings of a heparinoidvia anticoagulant dispenser 567, responsive to a bleeding risk such as abrain tumor or history of gastrointestinal bleeding). In some instances,a user may signal an anticoagulant application in lieu of explicitlyentering such a diagnosis. Alternatively or additionally, aless-specific pathology such as “cannot safely receive systemicanticoagulation” can be interpreted in a like fashion.

Operation 3026 describes customizing one or more apertures of the stentresponsive to the parameter relating to the specific patient (e.g. lasercontroller 578 implementing a stent in a convergent flow path, such asin a vein). Alternatively or additionally, one or more divergent flowpaths can be facilitated such as by branch outlet 1803 of stent 1800 ofFIG. 18.

Operation 3027 describes associating a medication regimen with thespecific patient (e.g. regimen implementer 594 signaling a structurewith a long-lasting antiproliferative agent responsive to a medicalhistory 593 indicating the patient's risk of vascular stenosis fromstenting). In some embodiments the antiproliferative agent can becovered at first with an antiplatelet agent or an antibiotic.

Operation 3028 describes implementing the medication regimen associatedwith the specific patient ex situ (e.g. regimen implementer 594generating a recipe for a succession of medication-containing coatingsresponsive to user-input dosage profiles like those of FIGS. 27 & 29. Insome embodiments a user selects from a variety of defined dosageprofiles of therapeutic agents such as angiogenic agents,anti-inflammatories, anti-leukocytes, antilymphocytes, antimitotics,antioxidants, antiproliferatives, anti-restenotics, beta blockers,cardio protectants, hormones, hypertension drugs, immunosuppressants,retinoids, statins, thrombolytics, vasoactive agents, or the like.

Operation 3029 describes customizing a dosage of a portion of the stentresponsive to the parameter relating to the specific patient (e.g.dosage profile 595 indicating a specific coating pattern that is thickerand more strongly bonded in a case for which a patient needs atherapeutic agent that can last for several months or more). In someinstances, dosage profile 595 can supplement the stent's therapeuticagent with a systemic application of the agent. In other instances, asystemic application of the therapeutic agent can be reduced or omittedso long as a stent will continue to administer the therapeutic agent.

Referring now to FIG. 31, there are shown several variants of the flow200 of FIG. 2 or 30. Operation 210—receiving a parameter relating to aspecific patient—may include one or more of the following operations:3113, 3116, or 3117. Operation 220—customizing one or more attributes ofa stent ex situ as an at-least-roughly contemporaneous response toreceiving the parameter relating to the specific patient—may include oneor more of the following operations: 3122, 3123, 3125, 3127, 3128, or3129.

Operation 3113 describes receiving an indication of a digestive systemstructure as the parameter relating to the specific patient (e.g.digestive type input 423 indicating “yes” responsive to a stenting sitein the digestive system as shown in FIG. 20). In some embodiments such atype may cause a stent to be customized with one or more of anantibiotic, a larger flexibility, or a chemically inert surface, forexample. In some instances the digestive type input can likewise berecorded in the specific patient's medical history to indicate what kindof stent was used or what caused that kind of stent to be used, forexample to track a stent failure rate by context.

Operation 3116 describes receiving one or more dimensions including atleast the parameter relating to the specific patient (e.g. dimensionalinput 416 receiving a diameter of anomaly 1174 as seen by sensor array1121). In some embodiments, a heuristic model of a round anomaly with adefined center and diameter sufficiently characterizes an occlusiontarget so that further shape information need not be obtained.

Operation 3117 describes receiving stent component quantity informationwith the parameter relating to the specific patient (e.g. inventorystatus information 419 indicating that the stent includes patch 1322 asa component). This can facilitate costing, insurance coverage, inventoryadjustment, or the like when and if stent 1350 is constructedphysically.

Operation 3122 describes forming an antiproliferative surface of thestent (e.g. applicator controller 564 applying a compound containing theantiproliferative(s) onto the stent via antiproliferative agentdispenser 565). In some embodiments, the antiproliferative surface of astent body is covered by one or more additional layers such as those ofFIGS. 26 & 28.

Operation 3123 describes applying at least one of an anticoagulant or ananti-platelet agent to the stent after forming the antiproliferativesurface of the stent (e.g. applicator controller 564 applying ananticoagulant-containing mixture onto a coated stent via anticoagulantdispenser 567). In the embodiment of FIG. 26, for example, a relativelythin layer of antiproliferative is applied to sheet material 2612 (bydipping or spraying, e.g.) as second agent 2615. The first agent 2618can optionally be applied afterward to at least a portion of secondagent 2615.

Operation 3125 describes bending a component of the stent ex situ as theat-least-roughly contemporaneous response to receiving the parameterrelating to the specific patient (e.g. sheet bender controller 573implementing a pleating pattern like that of FIG. 15 with sheet bender503 to fit stent 1550 into a catheter larger than diameter 1567,responsive to an indication that such a catheter is or will be used forthe specific patient). Alternatively or additionally, operation 3125 canbe performed upon a heuristic model, such as by model implementer 563.In some embodiments, more than ten pairs of pleats are used to fit alarge stent through a selected catheter.

Operation 3127 describes forming a flow occlusion portion of the stentresponsive to the parameter relating to the specific patient (e.g. presscontroller 575 forming few or no openings in flow occlusion portion 1821while making stent 1800). In some embodiments, stamp controller 575simultaneously forms other structural features of stent 1800 such aspleats, flow holes, pliability holes (e.g. holes 925 of FIG. 9).

Operation 3128 describes modifying a stiffness of the stent responsiveto the parameter relating to the specific patient (e.g. sheet stretchercontroller 574 can reduce a stiffness of a sheet material 910 or sheetmaterial 2612 with sheet stretcher 504, responsive to an indication thatthe unstretched stock is too stiff). Alternatively or additionally,pliability-enhancing holes (such as those of FIG. 9) or etching ormachining or the like can be used for a similar reduction of stiffness.

Operation 3129 describes customizing the one or more attributes of thestent ex situ within one month of receiving the parameter relating tothe specific patient (e.g. model implementer 563 adapting a definedstent responsive to one or more of patient identifier input 413,material identifier input 415, image input 418, validations, or the likeresponsive to expert guidance from various specialists who provide theinput data at various times). In various embodiments, an least aninitial customization can be performed within a narrower interval—e.g.within one week, within one day, within one hour, or within about tenminutes of measuring or otherwise receiving the parameter. After theinitial customization, of course, a virtual or physical stent may becompleted, retrofitted, updated, further customized, or the like, withinthe scope of these teachings.

Operation 3211 describes retrieving a record including at least theparameter relating to the specific patient (e.g. network interface 435requesting a medical history or other record transfer from a remote datasource, not shown). Alternatively or additionally, the retrieval caninclude an at-least-roughly contemporaneous completion deadline, adiagnosis, an angiographic reconstruction, or the like.

Referring now to FIG. 32, there are shown several variants of the flow200 of FIG. 2, 30, or 31. Operation 210—receiving a parameter relatingto a specific patient—may include one or more of the followingoperations: 3211, 3214, 3215, 3216, or 3217. Operation 3250 describesperforming one or more additional operations (e.g. machine interface 571compressing the customized stent into an off-the-shelf cathetersegment). In some embodiments, operation 3250 can include furtheraspects of customization, billing, shipping, quality control, materialinventory control, component testing, market trends, field performancetracking, regulatory compliance, or the like, for example. In someembodiments, operation 3250 may include one or more of the followingoperations: 3252, 3253, or 3259.

Operation 3214 describes prompting user input (e.g. output device 133 orthe like prompting an input from a surgeon or other informationprovider). In some instances, output device can comprise a displayscreen or audio interface in a user environment, for example.

Operation 3215 describes receiving the parameter relating to thespecific patient via an interface after prompting the user input (e.g.input device 134 or the like receiving a patient name or status as theparameter relating to the specific patient). In some instances, theparameter can take a default value directly from an MRI or similar datagathering device, responsive to a lack of response from an emergencyroom doctor. A stent customization can thus occur, in some embodiments,as a direct response to a patient need and without any contemporaneousparticipation by a care provider.

Operation 3216 describes receiving a pathological indication with theparameter relating to the specific patient (e.g. message parser 450receiving a medical history or the like indicating that the specificpatient has been diagnosed with cholangiocarcinoma). In someembodiments, such an indication can bear toward a stent with a localchemotherapy regimen, for example.

Operation 3217 describes receiving shape information including at leastthe parameter relating to the specific patient (e.g. dimensional input416 receiving several three dimensional models from MRI readings,showing how a shape of a segment of specific patient's basilar arterychanges during a heartbeat). In some embodiments dimensional input 416is received as an automatically generated default stent design enablinga surgeon to review and alter the design before providing anauthorization to build the actual stent.

Operation 3252 describes marking the stent ex situ with identifyinginformation relating to the one or more customized attributes of thestent (e.g. scribe controller 572 identifying a model or serial numberof “XLT259” in an X-ray readable form with scribe 502). In someembodiments a portion of this number signify a material, structure, orsubcomponent manufacturer explicitly (such as the “T” signifyingtitanium in this example). In some embodiments the number can be relatedto a customized component, for example, by including record 585 linkingthat identifier with one or more attributes (such as a sheet thickness)in table 582.

Operation 3253 describes aggregating data including at least theparameter relating to the specific patient and other information in adatabase (e.g. data aggregator 599 archiving stent manufacturing recordswith a patient or stent identifier). In some embodiments the records caninclude drug or material sources, exact dimensions, date and place ofmanufacture, stent designer, patient, intended site, caregiver, or thelike. Alternatively or additionally, some of this information may bewritten explicitly on the stent. Such information can later becorrelated with stent failures, for example.

Operation 3259 describes recording an identifier of the stent with theparameter relating to the specific patient (e.g. storage manager 591recording a custom stent serial number or specification in medicalhistory 593). In some embodiments the medical history 593 can furtherindicate a custom stent order date, a stent shipment date, or othercontemporaneous patient information including the parameter(s) affectingcustomization.

Referring now to FIG. 33, there are shown several variants of the flow200 of FIG. 2, 30, 31, or 32. Operation 210—receiving a parameterrelating to a specific patient—may include one or more of the followingoperations: 3313 or 3316. Operation 220—customizing one or moreattributes of a stent ex situ as an at-least-roughly contemporaneousresponse to receiving the parameter relating to the specific patient—mayinclude one or more of the following operations: 3322, 3323, 3324, 3327,or 3328.

Operation 3313 describes receiving information at least partly relatingto a stent inventory shortage including at least the parameter relatingto the specific patient (e.g. inventory status input 419 and stent typeinput 425 jointly receiving indications that a surgeon wants stentmodels A, B, and C for a specific patient, and that stent model B is notin stock). In some embodiments the arrival of the stent type input 425via message parser 450 triggers an automatic inquiry for inventorystatus input 419, for example.

Operation 3316 describes receiving an indication of a linkage betweenthe parameter and the specific patient (e.g. message parser 450receiving a record indicating that patient Greg Johnson had anabnormally high blood pressure reading on April 17). In this instance,patient identifier input 413 can identify Greg Johnson, for example witha patient number or the like. The parameter can be “HBP” or a numericmeasurement of blood pressure as measurement input 411 or the like.

Operation 3322 describes configuring one or more lateral sleeves in aportion of the stent responsive to the parameter relating to thespecific patient (e.g. model implementer 563 generating stent model 2210including sleeve 2231 and sleeve 2232 responsive to an angiographicreconstruction including site model 2200). In some embodiments bondercontroller 579 performs operation 3322 by applying a portion of stentmodel 2210 to sleeve inventory 546 to affix sleeve 2311 and sleeve 2312physically to stent body 2379.

Operation 3323 describes configuring one or more pleats of the stent exsitu responsive to the parameter relating to the specific patient (e.g.sheet bender controller 573 applying stent model 2210 to form annularpleats 2515 with sheet bender 503). In other embodiments, sheet bendercontroller 573 can configure pleat 1651 and pleat 1652 in theconfiguration of FIG. 16 responsive at least to outer diameter 1667.

Operation 3324 describes combining at least a first stent component anda second stent component responsive to information including at leastthe parameter relating to the specific patient (e.g. bonder controller579 supporting an occlusive patch 1322 with a non-occluding expandablewire frame 1321, such as by gluing them at an array of bonding points).In other embodiments a patch, flexible skin, or the like can bebuttressed by a wire frame without substantial bonding.

Operation 3327 describes cutting one or more flow holes in a componentof the stent responsive to the parameter relating to the specificpatient (e.g. laser controller 578, press controller 575, a drill, apunch, or the like cutting a flow hole to form branch outlet 1803 beforeor after rolling a sheet material into a tube). In some embodiments theflow hole sizes are selected to match stock sizes of sleeves, bloodvessel sizes, or the like consistent with the requirements of thestenting site and other medical objectives.

Operation 3328 describes including an antibiotic on the stent responsiveto the parameter relating to the specific patient (e.g. applicatorcontroller 564 using antibiotic dispenser 568 for implementing athickness, surface area, active ingredient concentration, binding agentconcentration, drug placement, complementary regimen, or the like toachieve dosage profile 595 selected for the patient). In someembodiments, a flow rate through the intended stent affects a computermodel that predicts an antibiotic elution rate for the heuristic stentmodel.

Referring now to FIG. 34, there are shown several variants of the flow300 of FIG. 3. Operation 330—receiving a parameter relating to aspecific patient—may include one or more of the following operations:3432 or 3434. Operation 340—customizing one or more junctions of a stentex situ in response to the received parameter relating to the specificpatient—may include one or more of the following operations: 3443, 3444,3445, 3447, or 3449.

Operation 3432 describes receiving a measurement as the parameterrelating to the specific patient (e.g. measurement input 411 receiving avascular segment length, vascular diameter, vascular wall plaquedimension, vascular calcification level, vascular branch or occlusionlocation coordinates, or the like). In some embodiments, the measurementcan identify a systemic deficiency such as a deficiency of AntithrombinIII, Protein C, or Protein S, signaling a hypercoaguability risk. Riskslike these can bear toward a more sparing use of stents or a liberal orlong-lasting local or systemic regimen of anticoagulants. This canoccur, for example, in embodiments in which operation 330 is performedby receiver 430 and in which operation 340 is performed by processingmodule 580.

Operation 3434 describes receiving a category identifier as theparameter relating to the specific patient (e.g. patient identifierinput 413 receiving an indication that a stent is to be provided for acancer patient, an elderly patient, a patient with an allergy, or thelike). Alternatively or additionally, the category identifier can relateto a risk type, a placement site, a stent material, a model name, anemergency status, or the like.

Operation 3443 describes receiving a heuristic model of the one or morejunctions of the stent (e.g. network interface 561 receiving stent model2210, which includes sleeve 2231 joining a conduit between flow port2201 and flow port 2202). In some embodiments, junctions combine lengthsof a stent along a flow path, such as in cases in which a single stentlength or width is too large to deploy through a tortuous access. Stent2300, for example, may be difficult to implant through a femoral artery(not shown) and iliac artery 2235, especially if implemented in a thickmaterial. In one variant, body 2379 is formed and installed initiallywith openings in lieu of sleeves 2311, 2312, and 2316. Each of thesleeves 2311, 2312, and 2316 can then be placed into its respectiveopening in turn, the junctions between each sleeve and body 2379comprising a custom-built friction fit or the like.

Operation 3444 describes updating the heuristic model with the receivedparameter relating to the specific patient (e.g. model implementer 563and network interface 561 adjusting stent model 2210 to indicate a“High” tortuosity of an access path through iliac artery 2235). In someembodiments, such an indicator may correspond with a small radius ofaccess vessel curvature, for example, necessitating a looser pleatingconfiguration so that a relatively large and thick stent body materialis not deformed inelastically during implantation.

Operation 3445 describes customizing the one or more junctions of thestent with the received heuristic model of the one or more junctions ofthe stent updated with the received parameter relating to the specificpatient (e.g. press controller 575 forming holes in body 2379 via theadjusted stent model 2210 and press 505). The sleeve joints can beadjusted, in this example, so that they are compatible with a design ofbody 2379 that can survive passage through the tortuous access path.

Operation 3447 describes adapting the one or more junctions of the stentresponsive to the received parameter relating to the specific patient(e.g. model implementer 563 and press controller 575 respectivelyperforming operations 3444 and 3445). Alternatively or additionally,operation 3447 can include substance applicator 569 selecting secondagent 2615 as a material that can more effectively bind first agent 2618to sheet material 2612. In some embodiments, machine interface 571performs operation 3447 by joining junction edges 931, 932 with anadhesive to which the patient is not allergic, responsive to an allergyindication of the patient).

Operation 3449 describes customizing the one or more junctions of thestent as an at-least-roughly contemporaneous response to receiving theparameter relating to the specific patient (e.g. sheet bender controller573 customizing locations of pleats 1651, 1652 with sheet bender 503 sothat successive pleats are of irregular spacing, responsive to anindication of a small catheter diameter for the patient). In someembodiments, access vessel diameter and other patient attributes orcircumstances dictate a maximum inner diameter of a catheter to be used,for example. Each of the pleats 1651, 1652 in FIG. 16 joins a widersmooth portion to a narrower smooth portion, for example. (Thisdifference facilitates a slight curl of the smooth portions, as shown.)This junction placement configuration permits width differences morethan 5% between successive smooth portions, as shown, which facilitatesthe spiral pleating configuration.

Referring now to FIG. 35, there are shown several variants of the flow600 of FIG. 6. Operation 610—obtaining a parameter relating to a stentinventory shortage—may include one or more of the following operations:3513, 3515, or 3518. Operation 620—configuring a stent with a flowocclusion portion in response to the obtained parameter relating to thestent inventory shortage—may include one or more of the followingoperations: 3521, 3522, 3523, 3527, or 3528.

Operation 3513 describes receiving data at least partly relating to aspecific patient including at least the parameter relating to a stentinventory shortage (e.g. inventory status input 419 receiving anindication that no Blue Cross Network healthcare provider currently hasa 10% tapering 23 millimeter stent in inventory, responsive to aninquiry identifying the provider and describing the stent type sought).Alternatively or additionally, in some embodiments, the flow occlusionportion of operation 620 is configured in response to the parameterrelating to the stent inventory shortage (e.g. shrinking or enlargingflow occlusion portion 922 to adapt an almost-ideal stent responsive toan indication that the ideal stent is currently out of stock). This canoccur, for example, in embodiments in which operation 610 is performedby receiver 430 and in which operation 620 is performed by processingmodule 580.

Operation 3515 describes receiving an indication of a position of ananatomical feature as the parameter relating to the stent inventoryshortage (e.g. image input 418 receiving one or more MRI or ultrasoundimages each with a descriptive annotation indicating that a potentialstenting site of a ureter is depicted). In some instances such anannotation can cause model implementer 563 to customize the stent bysignaling applicator controller 564 to include an antibiotic, forexample.

Operation 3518 describes receiving an indication of an aperture as theparameter relating to the stent inventory shortage (e.g. model input 412receiving an indication that no stents with secondary apertures largerthan 1.1 millimeters in diameter are presently inventoried). In someinstances, the received indication may explicitly rank available stentsor sheet components in a decreasing order of aperture size match orother suitability indicator. Alternatively or additionally, the rankingmay take into account other factors such as an expected custom-stentcompletion date.

Operation 3521 describes binding an antiproliferative agent to the flowocclusion portion of the stent (e.g. applicator controller 565 bindingthe agent to at least a portion of an occlusion site at patch 1322 ofFIGS. 13-14). This binding can be performed by dipping at least aportion of patch 1322 into antiproliferative agent dispenser 565(containing rapamycin or cyclosporine, for example) before collapsingstent 1350.

Operation 3522 describes customizing the stent with information relatingto a specific patient, the information relating to the specific patientincluding at least the obtained parameter relating to the stentinventory shortage (e.g. applicator controller 564 or machine interface571 customizing a coating or structure of a stent component responsiveto the specific patient's stenosis risk factors). The flow occlusionsite can be widened, or a coating of the site can be made to include astronger antiproliferative agent, for example, responsive to a highrestenosis risk.

Operation 3523 describes allocating the customized stent to the specificpatient (e.g. inventory controller 540 modifying stent inventory 542 toindicate that the stent is sold or otherwise reserved for the specificpatient relating to specifications used in making that stent). In someembodiments, only a single attribute of the patient can affect a mode ofstent customization (e.g. impregnating the stent with an antibioticresponsive to a presence of infection, and otherwise using anoff-the-shelf stent). In other embodiments, a combination of patientattributes can affect the mode of stent customization (e.g. selecting avascular stent size responsive to a combination of indications: size anddegree of calcification of a specific vessel, e.g.).

Operation 3527 describes obtaining one or more dimensions of the flowocclusion portion of the stent (e.g. data manager 590 retrieving one ormore of a length, width, or thickness of the flow occlusion portion fromtable 586 responsive to a model identifier of a stent in short supply).In some embodiments, such dimensions can be used for determining afeasibility of constructing an inventory of (a) structurally equivalentflow occlusion stents or (b)functionally-equivalent-but-structurally-distinct flow occlusion stents,closely resembling a stent model approved by the Food and DrugAdministration. In some embodiments such determinations can be madeautomatically, for example in facilitating an efficient mode ofcompliance with FDA guidelines.

Operation 3528 describes configuring the flow occlusion portion of thestent as the response to the obtained parameter relating to the stentinventory shortage (e.g. model implementer 563 generating a feasibleheuristic stent model by adapting the above-referenced approved model toincorporate only components that are available). Machine interface 571or a remote counterpart thereof can then use the adapted model toconfigure one or more physical components.

Referring now to FIG. 36, there are shown several variants of the flow600 of FIG. 6 or 35. Operation 610—obtaining a parameter relating to astent inventory shortage—may include one or more of the followingoperations: 3613, 3614, 3616, or 3618. Operation 620—configuring a stentwith a flow occlusion portion in response to the obtained parameterrelating to the stent inventory shortage—may include one or more of thefollowing operations: 3621, 3622, 3624, 3625, 3626, or 3627.

Operation 3613 describes receiving a stent quantity indicator as theparameter relating to the stent inventory shortage (e.g. inventorystatus input 419 receiving an indication that a surgeon has asked toreserve one of stent type X and two of stent type Y, and but that onlyone of each is in stock). In some embodiments an output device indicatesa shortage quantity (of the type X, for example) or a proposal for a lotsize to be produced.

Operation 3614 describes receiving a material composition indicator asthe parameter relating to the stent inventory shortage (e.g. materialidentifier input 415 indicating that anti-platelet-agent-coated stentsare sought from an inventory). In some embodiments model input 412 cancombine this with inventory status input 419 to reply that no suchstents are available from the inventory, or that only two14-millimeter-long stents with the specified coating are available.

Operation 3616 describes receiving a shape indicator as the parameterrelating to the stent inventory shortage (e.g. message parser 450receiving an oblong or arc-shaped indicator relating to a surgeon's“ideal stent” model). The shape indicator can be used for generating a“default stent” design that specifies sheet materials, wire materials,medications, coatings, or the like.

Operation 3618 describes receiving a size indicator as the parameterrelating to the stent inventory shortage (e.g. dimensional input 416receiving a diameter, thickness, length, or other feature size relatingto an inventoried stent, a readily-made stent, an anatomical featuresize for stent customization, or the like). In some embodiments the sizeindicator is retrieved or requested or accepted via a search tool or abrowser, for example.

Operation 3621 describes configuring a wire structure in response to theparameter relating to the stent inventory shortage (e.g. one or moreportions of applicator controller 564 forming wire material 2812 into agenerally tubular shape). In some embodiments, those skilled in the artcan implement operation 3621 by applying teachings herein to adaptconstruction techniques described in documents like U.S. patentapplication Ser. No. 10/104,672 (“Modular Stent Graft Assembly and UseThereof”). Alternatively or additionally, an elastic coating can be usedso that deforming the stent will minimize a risk of breakage in thecoating. In other embodiments an elastic binding agent is used before orafter the primary coating, substantially preventing such breakage.Alternatively or additionally, the primary coating can primarily beapplied to portions of sheet material 2612 or wire material 2812 that donot substantially change shape during stent compression or expansion.

Operation 3622 describes constructing the stent with the flow occlusionportion by supporting a flow occlusion structure with the wire structure(e.g. bonder controller 579 assembling the stent with bonder 509 usingan occlusive structure customized for identified needs of the specificpatient). In some embodiments, press controller 575 can form thestructure before the assembly. Alternatively or additionally, networkinterface 561 can custom-order the occlusive structure.

Operation 3624 describes configuring the flow occlusion portion as apart of the response to the obtained parameter relating to the stentinventory shortage (e.g. substance applicator 569 at least partlycoating portion 922 of stent 1000 to implement a patient-specificregimen like that shown in FIG. 27). In some embodiments, those skilledin the art can implement operation 3624 by applying teachings herein toadapt coating techniques described in documents like U.S. patentapplication Ser. No. 10/915,980 (“Method for Applying Drug Coating to aMedical Device in Surgeon Room”).

Operation 3625 describes configuring the stent with the flow occlusionportion as an at-least-roughly contemporaneous response to obtaining theparameter relating to the stent inventory shortage (e.g. substanceapplicator 569 adding material to a mesh so as to build it up into aflow occlusion portion). In some embodiments substance applicator 569can essentially pour a viscous biocompatible liquid resin onto the mesh,for example, hardening into a solid occlusion site.

Operation 3626 describes forming a sheet material into a rigid elementin response to the obtained parameter relating to the stent inventoryshortage (e.g. bonder controller 579 adhesing or otherwise attachingjunction edge 931 with junction edge 932 in response to a stent orvessel diameter or circumference consistent with stent profile 1067). Insome embodiments, bonder controller 579 controls bonder 509 remotely orwith some human assistance. Alternatively or additionally, anotherportion of machine interface 571 performs a prior operation of cuttingsheet material 910 responsive to the obtained parameter.

Operation 3627 describes including at least the rigid element in thestent (e.g. custom processor 560 including at least sheet material 910in stent 1000). Portions of custom processor 560 can likewise performadditional operations such as coating sheet material 910 as sheetmaterial 2612 (e.g. by portions of applicator controller 564 asdescribed herein and shown in FIG. 26).

Referring now to FIG. 37, there are shown several variants of the flow600 of FIG. 6, 35, or 36. Operation 610—obtaining a parameter relatingto a stent inventory shortage—may include one or more of the followingoperations: 3711, 3712, 3714, 3716, or 3719. Operation 620—configuring astent with a flow occlusion portion in response to the obtainedparameter relating to the stent inventory shortage—may include one ormore of the following operations: 3721, 3722, 3725, 3727, or 3728.

Operation 3711 describes prompting user input (e.g. output device 433displaying “High” pliability, a “2-3 mm” installed diameter, a “1.5 mmmax” collapsed diameter each as default parameter values a user canchange via input device 434). In some embodiments, input device 134includes a pointing device such as can be used to adjust any of thesefrom a pop-up menu of allowable choices. In some embodiments, these orother parameters can be assigned to any value.

Operation 3712 describes receiving the parameter relating to the stentinventory shortage via an interface after prompting the user input (e.g.model input 412 receiving an indication that zero off-the-shelf stentssatisfy a sufficiently high percentage of criteria comprising the userinput). In some embodiments, model input 412 may then request a customstent specification using component inventory information such as sheettype input 427, and indicate this specification via output device 433 asthe parameter(s) relating to the stent inventory shortage.

Operation 3714 describes receiving an indication of a vascular systemstructure as the parameter relating to the stent inventory shortage(e.g. vascular type input 422 indicating “true” generally to indicate avascular device, blood vessel(s) for which the stent(s) are sought, orthe like). Categorical information like this can be used for retrievingrelated models, case histories, available stent and stent componentinventories, or the like. It can also be used for deciding upon acustomized or off-the-shelf stent, coating, or structural component, forexample. In some embodiments, a text-valued vascular type input canlikewise be received, such as a blood vessel name.

Operation 3716 describes retrieving the parameter relating to the stentinventory shortage from an inventory (e.g. inventory status input 419and network interface 435 jointly requesting and receiving a stent orstent component inventory status of all available sources within 100kilometers of the requester). The identifiers and quantities in theretrieved aggregate stent or stent component inventory can eachconstitute parameters relating to the stent inventory shortage that canbe useful in some instances.

Operation 3719 describes receiving a message comprising at least theparameter relating to the stent inventory shortage (e.g. message parser450 receiving an advertisement or other source indication that canprovide a wire type input such as a wire gauge or wire alloydescription). In some embodiments, message parser 450 may be implementedas a web crawler that independently gathers stent information fromdiverse suppliers or specifications.

Operation 3721 describes configuring the stent with a pleatconfiguration responsive to the obtained parameter relating to the stentinventory shortage (e.g. sheet bender controller 573 forming helical orother substantially curvaceous pleats with sheet bender 503). See, forexample, pleats 1652 of FIG. 16. In some embodiments, acollapse-pleating configuration can be computer-optimized to minimize arisk of buckling or other damage as a custom-pleated stent passesthrough a real catheter mimicked by a heuristic catheter model. Forexample, in some instances a catheter can be modeled adequately by aninner diameter (such as diameter 1667 of FIG. 16) and a degree oftortuosity (such as H, M, or L). In some embodiments thecollapse-pleating configuration can likewise take into account an innerdiameter of a collapsed stent (such as diameter 1668 of FIG. 16) orother factors as described herein.

Operation 3722 describes including the flow occlusion portion of thestent responsive to the obtained parameter relating to the stentinventory shortage (e.g. stock designator 562 and sheet inventory 541jointly nominating sheet material 910 having flow occlusion portion 922responsive to indications that sheet material 910 is the only on-sitecomponent of a desired rigidity and that flow occlusion portion 922 willnot impair stent performance). Of course in other embodiments, asexplained above, a flow occlusion portion may be a value-enhancing stentfeature, a required search criterion, or a significant feature presentedto a system user to facilitate the system user's stent selection. Alsoin other instances the flow occlusion portion is included by machineinterface 571 configuring the stent physically with such a feature.

Operation 3725 describes configuring the stent with a dividing flow pathresponsive to the obtained parameter relating to the stent inventoryshortage (e.g. machine interface 571 automatically configuring stent1800 with flow outlet 1802 and at least branch outlet 1803, responsiveto an indication that no suitable branching stents are available ininventory). In some embodiments, operation 3725 is initially performedvirtually, yielding an image like FIG. 18 as a heuristic model. A largenumber of such models can be kept as a virtual “inventory,” in someimplementations, optionally including linkages to component availabilityinformation that can bear upon a delivery time estimate.

Operation 3727 describes configuring the stent with the flow occlusionportion in response to a pathological indication and to the obtainedparameter relating to the stent inventory shortage (e.g. plant 570causing press controller 575 to create a flow occlusion site more than90% blocked, responsive to an indication of an arterial rupture).Alternatively or additionally, the flow occlusion portion can beimplemented as a thrombogenic surface positioned in a thrombogenictarget zone such as that shown in FIGS. 18 & 19.

Operation 3728 describes applying information retrieved relating to thestent with the flow occlusion portion (e.g. sheet bender controller 573implementing one or more pleats in sheet material 910 or in stent 1000responsive to information about flow occlusion portion 922). In someinstances, pleats may be denser in a remainder (e.g. mesh portion 921)of a sheet component, or may be omitted entirely from a flow occlusionportion to minimize inelastic deformation.

Referring now to FIG. 38, there are shown several variants of the flow700 of FIG. 7. Operation 760—receiving a parameter relating to aspecific patient—may include one or more of the following operations:3863 or 3869. Operation 770—configuring a stent with a flow occlusionportion in response to receiving the parameter relating to the specificpatient—may include one or more of the following operations: 3871, 3873,3875, 3876, or 3878.

Operation 3863 describes obtaining an identifier of the specific patientas the parameter relating to the specific patient (e.g. patientidentifier input 413 requesting the patient's identification numberresponsive to name fragments received, such as from an intake nurse).Alternatively or additionally, complete or local records for the patientcan be retrieved directly in response to the name fragments or otherpatient identifier initially received. This approach can accelerate astent customization, for example, especially in or near an emergencycare facility. This can occur, for example, in embodiments in whichoperation 760 is performed by receiver 430 and in which operation 770 isperformed by processing module 580.

Operation 3869 describes obtaining medical history information includingat least the parameter relating to the specific patient (e.g. messageparser 450 assembling the patient's history as portions thereof arrive,and extracting at least a reasonably current vessel diameter as theparameter). In some embodiments, model input 412 instead generates stentdiameter or thickness as the parameter (from the vessel diameter, e.g.).

Operation 3871 describes forming the flow occlusion portion of the stentby supporting a substantially occlusive layer with a rigidflow-permeable mesh (e.g. bonder controller 579 affixing patch 1322 toframe 1321 with bonder 509). For variants incorporating features likeoperation 3871, a layer can be substantially occlusive if it occludes atleast about 80% of a defined channel cross section. In some embodiments,a first and second stent portion are designed to be assembled in situ,such as by installing a film, a somewhat flimsy stent, or the like andthen supporting it in situ against a vessel wall with a rigid frame. SeeFIG. 16. In some embodiments, those skilled in the art can implementoperation 3871 by applying teachings herein to adapt assembly techniquesdescribed in documents like U.S. patent application Ser. No. 10/737,314(“Assembly and Planar Structure for Use Therein Which is Expandable intoa 3-D Structure Such as a Stent and Device for Making the PlanarStructure”).

Operation 3873 describes heat-treating at least a portion of the one ormore stents responsive to the parameter relating to the stent inventoryshortage (e.g. machine interface 571 shaping nitinol or othersuperelastic material at 400° to 500° Celsius using a heuristic modelthat includes a temperature or other measurable parameter). In someembodiments, the parameter can be a thickness or other model dimensionor a treatment temperature. In some embodiments, those skilled in theart can implement operation 3873 by applying teachings herein to adaptconstruction techniques described in documents like U.S. patentapplication Ser. No. 10/826,028 (“Sizing and Shaping Device for TreatingCongestive Heart Failure”).

Operation 3875 describes removing material from the stent in theresponse to receiving the parameter relating to the specific patient(e.g. model implementer 563 forming notches, perforations, or the likeresponsive to an indication that a heuristic stent or component modelneeds a higher flexibility or coating elution rate). Operation 3875 canalso be performed physically, such as by a chemical etch (or by lasercontroller 578 or the like) forming or enlarging holes 925 of FIG. 9. Insome embodiments, mesh portion 921 can be made more flexible andflow-permeable as the diameters of holes 925 are increased slightly,responsive to a shortage, patient attribute, or the like.

Operation 3876 describes configuring the stent with a flow-permeablemesh in the response to receiving the parameter relating to the specificpatient (e.g. machine interface 571 positioning a diffuseemboli-deflecting mesh responsive to an indication that the permeatingflow will supply a carotid artery or other location vulnerable toemboli). In some embodiments, a diffuse emboli-deflecting mesh is onewith about 50 to 5000 flow holes per square centimeter and an effectiveareal coverage of at most about 20%.

Operation 3878 describes configuring the flow occlusion portion of thestent in the response to receiving the parameter relating to thespecific patient (e.g. substance applicator 569 or machine interface 571configuring thrombogenic surface 1863 of FIG. 18). In some embodiments,a thrombogenic surface can be a cellulose-based compound, a bare metal,or otherwise at least about as thrombogenic as pure titanium.

Referring now to FIG. 39, there are shown several variants of the flow800 of FIG. 8. Operation 880—obtaining a parameter relating to a stentinventory shortage—may include one or more of the following operations:3984 or 3986. Operation 890—specializing one or more stents in responseto obtaining the parameter relating to the stent inventory shortageconfiguring a stent with a flow occlusion portion in response to theobtained parameter relating to the stent inventory shortage—may includeone or more of the following operations: 3992, 3993, 3995, 3996, or3998.

Operation 3984 describes obtaining anatomical information including atleast the parameter relating to the stent inventory shortage (e.g.inventory controller 540 accessing stent inventory 542 to determine thatit includes no stents of suitable size and rigidity for effectivelystenting a trachea, esophagus, or the like). In some embodiments, such adetermination is made responsive to arithmetic combinations,quantitative comparisons or the like, substantially in lieu of specificanatomical name comparisons. This can occur, for example, in embodimentsin which operation 880 is performed by receiver 430 and in whichoperation 890 is performed by processing module 580.

Operation 3986 describes obtaining stent information including at leastthe parameter relating to the stent inventory shortage (e.g. wire typeinput 426 receiving an indication that a wire component of a heuristicstent model has a category of “custom” or other indication that the wireis not generic). In some embodiments, such an indication signifies thatsuch wire is never in inventory and must be special ordered or replacedwith some other design structure.

Operation 3992 describes exerting pressure on a component of the one ormore stents responsive to the parameter relating to the stent inventoryshortage (e.g. sheet bender controller 573 forming pleats 1415 withsheet bender 503 in a configuration substantially like that of a stentin short supply). In some embodiments, the component is assembled intothe stent(s) after operation 3992.

Operation 3993 describes specializing the one or more stents responsiveto a value of a parameter relating to a specific patient (e.g. networkinterface 561 causing stent 2150 to implement radius of curvature 2152for duct 2024 of patient 2000). In some embodiments, network interface561 configures stent 2150 via a manufacturing or customization facility(not shown) that can be remote from patient 2000 or system 500.

Operation 3995 describes removing a portion of the one or more stentsresponsive to the parameter relating to the stent inventory shortage(e.g. laser controller 578 scoring, notching, or otherwise removingmaterial with laser 508 along a pleat defined in a novel stent pleatingconfiguration identified by the parameter). Alternatively oradditionally, the removed portion may include a stent length portionremoved by cutting (via machine interface 571, e.g.) responsive to alength indicator. Alternatively or additionally, the removed portion mayinclude a stent thickness removed by chemical etching (via applicatorcontroller 564, e.g.) responsive to a thickness indicator. Alternativelyor additionally any portion of a virtual stent can be removed by modelimplementer 563, in some embodiments, responsive to a similar stentbeing depleted or otherwise in short supply.

Operation 3996 describes including an antibiotic in the one or morestents (e.g. antibiotic dispenser 568 applying a rapamycin-containingmixture locally in response to the parameter indicating that no betterantibiotic is apparently available commercially). In some embodiments, amessage describing this information can instead be provided to a doctorwho can then authorize or implement the rapamycin-including mixturecoating operation.

Operation 3998 describes forming an aperture in the one or more stentsresponsive to the parameter relating to the stent inventory shortage(e.g. machine interface 571 forming an opening responsive to flow port2202 of stent model 2210, responsive to an indication that flow port2202 is substantially unlike that of any stent in inventory). In someembodiments, such an indication can come from an interface such as byinput device 434, a mouse or other pointing device, or the like.

Referring now to FIG. 40, there is shown another exemplary environmentin which one or more technologies may be implemented. As shown localsystem 4000 includes receiving module 4030, customization module 4050and resources 4060 coupled, for example, by channel 4010. Local system4000 can also include first stent printer 4021, memory manager 4070,memory 4072, storage manager 4080 or storage 4082. Local system 4000 can(optionally) couple through linkage 4011 with remote elements such assecond stent printer 4022. In some embodiments portions of local system4000 such as design logic 4069 or storage 4082 can likewise beimplemented remotely.

As shown receiving module 4030 can (optionally) include one or more ofinterface 4031, message parser 4033 or input 4037. Message parser 4033can include one or more of identifiers 4034 or quantities 4035. Input4037 can include one or more of profile 4038 (patient data or profiles2700, 2900 of FIGS. 27 and 29, e.g.) or values 4039.

Customization module 4050 can include one or more of first applicatorlogic 4051, second applicator logic 4052, component assembler 4053,material removal logic 4054, press controller 4055, junction formationlogic 4056, flow occlusion logic 4057, composition logic 4058 or layerconfiguration logic 4059. Each of these items may optionally beimplemented as special purpose circuitry, as firmware, as software, oras general purpose circuitry configured with software in someembodiments.

Resources 4060 can include applicator 4001, applicator 4002, positioner4003, etching equipment 4004, press 4005, equipment interface 4006,modeling software 4007, ingredient combiner 4008 or machine interface4009. Resources 4060 can likewise include components 4061 (wire 4062,mesh 4063, patch 4064, or sheet 4065, e.g.), virtual site 4066, virtualstent 4067 and its components 4068, or design logic 4069. In someembodiments one or more of these resources can be implemented remotely,physically or virtually as exemplified below.

Referring now to FIG. 41, there are shown several variants of the flow300 of FIG. 3 or 34. Operation 340—customizing one or more junctions ofa stent ex situ in response to the received parameter relating to thespecific patient—may include one or more of the following operations:4141, 4144, 4146, 4148, or 4149. Operation 4150—performing one or moreadditional operations—may include one or more of the followingoperations: 4153, 4155, 4158, or 4159.

Operation 4141 describes forming a seam along at least a first edge of asheet element (e.g. junction formation logic 4056 using equipmentinterface 4006 to join abutting or overlapping edges sheet edges).Equipment interface 4006 can perform this function using a welder oradhesive applicator (not shown), for example. In some embodiments,operation 4142 can be performed based on or otherwise in response to areceived diameter or overlap distance relating to the specific patient,for example. Alternatively or additionally the received parameter(s) caninclude one or more of a medication, a dosage, a sheet identifier or thelike relating to a specific patient. This can occur, for example, inembodiments in which customization module 4050 performs operation 340and in which one or more resources 4060 perform operation 4150.

Operation 4144 describes joining a flow occlusion element with aflow-permeable element at a junction location at least partly based onthe received parameter relating to the specific patient (e.g. flowocclusion logic 4057 using modeling software 4007 for assembling virtualstent 4067 by affixing a patch to a mesh in a mutual position at leastpartly specified by the received parameter). The received parameter canindicate a menu selection of “toward the narrow end,” for example, or alongitudinal coordinate of 0.31 millimeters. Alternatively oradditionally, in some embodiments, flow occlusion logic 4057 can beconfigured to perform this operation upon a physical stent, such as bycoupling flow occlusion logic 4057 with a bonder or the like via amachine interface (not shown).

Operation 4146 describes engaging a first tubular element of the stentex situ with an open end of a second tubular element of the stent (e.g.component assembler 4053 using positioner 4003 for forming an end-to-endor other composite stent in response to one or more instructions). Theinstructions can include indications of click-and-drag user input or thelike, for example. In some embodiments, received parameters specifywhere the junction is (as coordinates, e.g.). Alternatively oradditionally, the parameters can explicitly indicate a degree of overlapor a crimping force, for example, used for joining stent components.

Operation 4148 describes infusing at least one of the one or morejunctions with a therapeutic agent (e.g. composition logic 4058 usingingredient combiner 4008 for mixing the therapeutic agent with abiocompatible binding agent). The therapeutic agent can include anantibiotic or other drug, an antiproliferative agent or the like.Including such agents within the junction(s) can permit a morecontrolled dosage profile, for example.

Operation 4149 describes configuring one or more pleats of the stent exsitu responsive to the received parameter relating to the specificpatient (e.g. press controller 4055 using press 4005 to customize theone or more pleats to achieve a degree of compression suitable for usein a specific stenting site within the patient). By positioning pleatsand other junctions in a manner that accommodates a degree of tortuosityneeded for access to a stenting site, for example, a stiffer or thickersheet material may become feasible for smooth portions of the stent insome implementations. Those skilled in the art will recognize that otheradvantages can be achieved by other modes of customization, in light ofteachings herein, without undue experimentation.

Operation 4153 describes generating at least one variant of the stent inresponse to the received parameter relating to the specific patient(e.g. second stent printer 4022 generating two or more stents ofdifferent sizes or compositions). In some embodiments the stents differin only one or two aspects that are well understood. This can, forexample, permit a surgeon to choose at the 11th hour, or even insurgery, between two or more stent versions that have been customizedfor the patient.

Operation 4155 describes engaging an open end of a first tubular elementof the stent with a second tubular element of the stent (e.g. componentassembler 4053 using positioner 4003 for arranging one or more of wire4062, mesh 4063, patch 4064 or sheet 4065 physically or virtually). Thiscan allow for coupling stent components end-to-end or in complexbranched configurations like that of FIG. 23, making stenting feasibleeven for complex vessel geometries like that of FIG. 22. A surgeon canalso perform operation 4155 in situ, such as by press-fitting taperedsleeves as shown in FIG. 23.

Operation 4158 describes displaying the at least a portion of the one ormore customized junctions of the stent (e.g. interface 4031 displayingcomponents 4068 of virtual stent 4067). Alternatively or additionally,interface 4031 can display a photograph of one or more components 4061of an actual stent.

Operation 4159 describes customizing one or more other features of thestent (e.g. customization module 4050 selecting components of the stentin response to other information relating to the specific patient). Insome embodiments, customization module 4050 can perform this operationjointly with storage manager 4080, for example, by retrieving data abouta stent component or other resources available for customizationoperations.

Referring now to FIG. 42, there are shown several variants of the flow300 of FIG. 3, 34, or 41. Operation 330—receiving a parameter relatingto a specific patient—may include one or more of the followingoperations: 4231, 4233, 4234, or 4237. Operation 340—customizing one ormore junctions of a stent ex situ in response to the received parameterrelating to the specific patient—may include one or more of thefollowing operations: 4242, 4244, 4245, 4246, 4247, or 4249.

Operation 4231 describes receiving an anatomical model of a portion ofthe specific patient (e.g. memory manager 4070 retrieving virtual site4066 or virtual stent 4067 from memory 4072 as a mathematicaldescription of one or more 3-dimensional objects). In some embodiments,virtual stent 4067 may be customized for the specific patient.Alternatively or additionally, design logic 4069 can be configured toadapt or generate such a stent using the virtual site 4066 or otherreceived anatomical data. Design logic 4069 can likewise (optionally) beconfigured to delegate some or all of this task to remote resources suchas second stent printer 4122. This can occur, for example, inembodiments in which receiving module 4030 performs operation 330 and inwhich customization module 4050 performs operation 340.

Operation 4233 describes receiving an identifier of the specific patient(e.g. message parser 4033 receiving one or more identifiers such as thepatient's name or identification number). In some embodiments, theidentifiers comprise the received parameter, optionally accompanied byother parameters such as a customized stent specification. Alternativelyor additionally, a patient identifier can be used to request a retrievalof other parameters.

Operation 4234 describes receiving an ingredient indication as theparameter relating to the specific patient (e.g. message parser 4033receiving one or more identifiers 4034 of drugs or sheet elements). Asheet element identifier may include an explicit identifier (e.g.Nitinol) or an implicit identifier (e.g. a catalog item of “A40”). Thoseskilled in the art will recognize a variety of trade names or otheridentifiers, for example, that indicate a material or other ingredientsuitable for use in customizing a stent. Alternatively or additionally,a component identifier can be used to request a retrieval of otherparameters.

Operation 4237 describes receiving a dimension as the parameter relatingto the specific patient (e.g. message parser 4033 receiving one or morequantities 4035 signifying widths or other shape data). The quantitiesmay define or otherwise describe an anatomical attribute amenable tocustomization, for example. Message parser 4033 may likewise receivedata that is not used for stent customization in some embodiments.Alternatively or additionally, message parser 4033 can be configured toreceive and interpret identifiers 4034 (e.g. as described above inrelation to operation 4233 or 4234).

Operation 4242 describes removing material from at least one stentcomponent in the response to the received parameter relating to thespecific patient (e.g. material removal logic 4054 using etchingequipment 4004 to remove a layer or to form holes). See, e.g., holes 925in FIG. 9. Alternatively or additionally, material removal logic 4054can reduce a layer thickness of one or more components 4068 of virtualstent 4067 in response to input 4037 from interface 4031. This can beimplemented physically, for example, by adding thinner to a bindingagent into which the wire or sheet element is dipped, or in directingthat fewer layers (e.g. successive applications) will be included.

Operation 4244 describes applying a first layer to a stent element inresponse to the received parameter relating to the specific patient(e.g. first applicator logic 4051 configuring applicator 4001 to controlan application of a layer to a sheet material or wire material). See,e.g. FIGS. 26 & 28. First applicator logic 4051 can, for example, beconfigured to control one or more of an applicator type (e.g. A sprayapplicator or an immersion system); a drug, binding agent or otheringredient; a temperature, duration, positioning or sequencing ofapplications or the like.

Operation 4245 describes forming one of the one or more junctionsbetween the first layer and a second layer by applying the second layerover the first layer (e.g. second applicator logic 4052 configuringapplicator 4002 to control an application of a new layer over a lowerlayer or other component of stent). Second applicator logic 4052 can,for example, be configured to control one of the above-referencedsystems, optionally including a control attribute responsive to input4037 or from interface 4031.

Operation 4246 describes configuring a dimension of a layer of the stentex situ in the response to the received parameter relating to thespecific patient (e.g. flow occlusion logic 4057 using modeling software4007 for configuring a length, width, thickness, or structure of a layerin response to input 4037 entered on behalf of the specific patient). Insome embodiments, the layer can comprise patch 4064, sheet 4065, athrombogenic material or the like. Alternatively or additionally, thedimension can comprise a value such as outer diameter 1667 of FIG. 16, alayer thickness or the like. The received parameter can include a radiusof curvature or other indicator of tortuosity, a vessel diameter, acalcification or age indicator, a pathologic indicator or the like.Modeling software 4008 can be configured to describe a position ofvirtual stent 4067 within virtual site 4066 using conventional3-dimensional rendering, for example, in light of these teachings. Insome variants, vessel shape or other patient attributes can be takeninto account in determining the appropriateness of a tapered ortight-fitting stent, for example. Alternatively or additionally, in someembodiments, flow occlusion logic 4057 can be configured to performoperation 4144 as described above.

Operation 4247 describes configuring a layer of the stent ex situ in theresponse to the received parameter relating to the specific patient(e.g. layer configuration logic 4059 using machine interface 4009 forconfiguring a length, width, or thickness of a layer in response toinput 4037 entered for the specific patient). In some embodiments, thelayer can comprise a flow occlusion structure as described in operation4246 or the dimension or the received parameter can include thosedescribed above. Alternatively or additionally, the material compositionof the junction(s) or layer(s) can be customized in response to thereceived parameter(s). A thinner or more pliable material may be used inresponse to an indication that the patient is elderly or that an accessvessel is highly tortuous, for example. Those skilled in the art willrecognize a variety of other customization opportunities to servepatients better in light of teachings herein.

Operation 4249 describes forming the one or more junctions of the stentex situ (e.g. first stent printer 4021 configuring a content orthickness of an inter-layer junction in response to a dosage profileselected or otherwise specified by input). the wire component 2700 canbe configured with two layers, in the example as shown in FIG. 27, inresponse to input 4037 indicating a profile like that of FIG. 28 (e.g.profile 2800). In one scenario, attributes of inventoried stentcomponents (respective mechanical properties or elution profiles, e.g.)Are displayed to a user who then selects a desired combination of thecomponents and activates first stent printer 4021 accordingly. Thoseskilled in the art will recognize that such profiles can be implementedwithout undue experimentation, for example, using inkjet technology orthe like in light of teachings herein.

It will be understood that variations in business models relating to thetechnologies described herein may prove advantageous, for example insituations in which an information systems consultant or other serviceprovider acts for the benefit of one or more clients or interests toachieve such technologies collectively. Such arrangements can facilitateorganizational or tool specialization and cost effectiveness, forexample, across distributed networks in the global marketplace. Thoseskilled in the art will recognize that such beneficial interactioncreates a commercial web constituting a single de facto entity of two ormore interacting participants cooperatively implementing the teachingsherein, within the scope and spirit of the claimed invention.

Those having skill in the art will recognize that the state of the arthas progressed to the point where there is little distinction leftbetween hardware and software implementations of aspects of systems; theuse of hardware or software is generally (but not always, in that incertain contexts the choice between hardware and software can becomesignificant) a design choice representing cost vs. efficiency tradeoffs.Those having skill in the art will appreciate that there are variousvehicles by which processes and/or systems and/or other technologiesdescribed herein can be effected (e.g., hardware, software, and/orfirmware), and that the preferred vehicle will vary with the context inwhich the processes and/or systems and/or other technologies aredeployed. For example, if an implementer determines that speed andaccuracy are paramount, the implementer may opt for a mainly hardwareand/or firmware vehicle; alternatively, if flexibility is paramount, theimplementer may opt for a mainly software implementation; or, yet againalternatively, the implementer may opt for some combination of hardware,software, and/or firmware. Hence, there are several possible vehicles bywhich the processes and/or devices and/or other technologies describedherein may be effected, none of which is inherently superior to theother in that any vehicle to be utilized is a choice dependent upon thecontext in which the vehicle will be deployed and the specific concerns(e.g., speed, flexibility, or predictability) of the implementer, any ofwhich may vary. Those skilled in the art will recognize that opticalaspects of implementations will typically employ optically-orientedhardware, software, and or firmware.

The foregoing detailed description has set forth various embodiments ofthe devices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, or examples can be implemented,individually and/or collectively, by a wide range of hardware, software,firmware, or virtually any combination thereof. In one embodiment,several portions of the subject matter described herein may beimplemented via Application Specific Integrated Circuits (ASICs), FieldProgrammable Gate Arrays (FPGAs), digital signal processors (DSPs), orother integrated formats. However, those skilled in the art willrecognize that some aspects of the embodiments disclosed herein, inwhole or in part, can be equivalently implemented in integratedcircuits, as one or more computer programs running on one or morecomputers (e.g., as one or more programs running on one or more computersystems), as one or more programs running on one or more processors(e.g., as one or more programs running on one or more microprocessors),as firmware, or as virtually any combination thereof, and that designingthe circuitry and/or writing the code for the software and or firmwarewould be well within the skill of one of skill in the art in light ofthis disclosure. In addition, those skilled in the art will appreciatethat the mechanisms of the subject matter described herein are capableof being distributed as a program product in a variety of forms, andthat an illustrative embodiment of the subject matter described hereinapplies regardless of the particular type of signal bearing medium usedto actually carry out the distribution. Examples of a signal bearingmedium include, but are not limited to, the following: a recordable typemedium such as a floppy disk, a hard disk drive, a Compact Disc (CD), aDigital Video Disk (DVD), a digital tape, a computer memory, etc.; and atransmission type medium such as a digital and/or an analogcommunication medium (e.g., a fiber optic cable, a waveguide, a wiredcommunications link, a wireless communication link, etc.).

In a general sense, those skilled in the art will recognize that thevarious embodiments described herein can be implemented, individuallyand/or collectively, by various types of electro-mechanical systemshaving a wide range of electrical components such as hardware, software,firmware, or virtually any combination thereof; and a wide range ofcomponents that may impart mechanical force or motion such as rigidbodies, spring or torsional bodies, hydraulics, and electro-magneticallyactuated devices, or virtually any combination thereof. Consequently, asused herein “electro-mechanical system” includes, but is not limited to,electrical circuitry operably coupled with a transducer (e.g., anactuator, a motor, a piezoelectric crystal, etc.), electrical circuitryhaving at least one discrete electrical circuit, electrical circuitryhaving at least one integrated circuit, electrical circuitry having atleast one application specific integrated circuit, electrical circuitryforming a general purpose computing device configured by a computerprogram (e.g., a general purpose computer configured by a computerprogram which at least partially carries out processes and/or devicesdescribed herein, or a microprocessor configured by a computer programwhich at least partially carries out processes and/or devices describedherein), electrical circuitry forming a memory device (e.g., forms ofrandom access memory), electrical circuitry forming a communicationsdevice (e.g., a modem, communications switch, or optical-electricalequipment), and any non-electrical analog thereto, such as optical orother analogs. Those skilled in the art will also appreciate thatexamples of electro-mechanical systems include but are not limited to avariety of consumer electronics systems, as well as other systems suchas motorized transport systems, factory automation systems, securitysystems, and communication/computing systems. Those skilled in the artwill recognize that electro-mechanical as used herein is not necessarilylimited to a system that has both electrical and mechanical actuationexcept as context may dictate otherwise.

In a general sense, those skilled in the art will recognize that thevarious aspects described herein which can be implemented, individuallyand/or collectively, by a wide range of hardware, software, firmware, orany combination thereof can be viewed as being composed of various typesof “electrical circuitry.” Consequently, as used herein “electricalcircuitry” includes, but is not limited to, electrical circuitry havingat least one discrete electrical circuit, electrical circuitry having atleast one integrated circuit, electrical circuitry having at least oneapplication specific integrated circuit, electrical circuitry forming ageneral purpose computing device configured by a computer program (e.g.,a general purpose computer configured by a computer program which atleast partially carries out processes and/or devices described herein,or a microprocessor configured by a computer program which at leastpartially carries out processes and/or devices described herein),electrical circuitry forming a memory device (e.g., forms of randomaccess memory), and/or electrical circuitry forming a communicationsdevice (e.g., a modem, communications switch, or optical-electricalequipment). Those having skill in the art will recognize that thesubject matter described herein may be implemented in an analog ordigital fashion or some combination thereof.

Those skilled in the art will recognize that it is common within the artto describe devices and/or processes in the fashion set forth herein,and thereafter use engineering practices to integrate such describeddevices and/or processes into data processing systems. That is, at leasta portion of the devices and/or processes described herein can beintegrated into a data processing system via a reasonable amount ofexperimentation. Those having skill in the art will recognize that atypical data processing system generally includes one or more of asystem unit housing, a video display device, a memory such as volatileand non-volatile memory, processors such as microprocessors and digitalsignal processors, computational entities such as operating systems,drivers, graphical user interfaces, and applications programs, one ormore interaction devices, such as a touch pad or screen, and/or controlsystems including feedback loops and control motors (e.g., feedback forsensing position and/or velocity; control motors for moving and/oradjusting components and/or quantities). A typical data processingsystem may be implemented utilizing any suitable commercially availablecomponents, such as those typically found in datacomputing/communication and/or network computing/communication systems.

Those skilled in the art will recognize that it is common within the artto implement devices and/or processes and/or systems in the fashion(s)set forth herein, and thereafter use engineering and/or businesspractices to integrate such implemented devices and/or processes and/orsystems into more comprehensive devices and/or processes and/or systems.That is, at least a portion of the devices and/or processes and/orsystems described herein can be integrated into other devices and/orprocesses and/or systems via a reasonable amount of experimentation.Those having skill in the art will recognize that examples of such otherdevices and/or processes and/or systems might include—as appropriate tocontext and application—all or part of devices and/or processes and/orsystems of (a) an air conveyance (e.g., an airplane, rocket, hovercraft,helicopter, etc.), (b) a ground conveyance (e.g., a car, truck,locomotive, tank, armored personnel carrier, etc.), (c) a building(e.g., a home, warehouse, office, etc.), (d) an appliance (e.g., arefrigerator, a washing machine, a dryer, etc.), (e) a communicationssystem (e.g., a networked system, a telephone system, a Voice over IPsystem, etc.), (f) a business entity (e.g., an Internet Service Provider(ISP) entity such as Comcast Cable, Quest, Southwestern Bell, etc), or(g) a wired/wireless services entity such as Sprint, Cingular, Nextel,etc.), etc.

One skilled in the art will recognize that the herein describedcomponents (e.g., steps), devices, and objects and the discussionaccompanying them are used as examples for the sake of conceptualclarity and that various configuration modifications are within theskill of those in the art. Consequently, as used herein, the specificexemplars set forth and the accompanying discussion are intended to berepresentative of their more general classes. In general, use of anyspecific exemplar herein is also intended to be representative of itsclass, and the non-inclusion of such specific components (e.g., steps),devices, and objects herein should not be taken as indicating thatlimitation is desired.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations are not expressly set forth herein for sakeof clarity.

The herein described subject matter sometimes illustrates differentcomponents contained within, or connected with, different othercomponents. It is to be understood that such depicted architectures aremerely exemplary, and that in fact many other architectures can beimplemented which achieve the same functionality. In a conceptual sense,any arrangement of components to achieve the same functionality iseffectively “associated” such that the desired functionality isachieved. Hence, any two components herein combined to achieve aparticular functionality can be seen as “associated with” each othersuch that the desired functionality is achieved, irrespective ofarchitectures or intermedial components. Likewise, any two components soassociated can also be viewed as being “operably connected”, or“operably coupled”, to each other to achieve the desired functionality,and any two components capable of being so associated can also be viewedas being “operably couplable”, to each other to achieve the desiredfunctionality. Specific examples of operably couplable include but arenot limited to physically mateable and/or physically interactingcomponents and/or wirelessly interactable and/or wirelessly interactingcomponents and/or logically interacting and/or logically interactablecomponents.

While particular aspects of the present subject matter described hereinhave been shown and described, it will be apparent to those skilled inthe art that, based upon the teachings herein, changes and modificationsmay be made without departing from the subject matter described hereinand its broader aspects and, therefore, the appended claims are toencompass within their scope all such changes and modifications as arewithin the true spirit and scope of the subject matter described herein.Furthermore, it is to be understood that the invention is defined by theappended claims. It will be understood by those within the art that, ingeneral, terms used herein, and especially in the appended claims (e.g.,bodies of the appended claims) are generally intended as “open” terms(e.g., the term “including” should be interpreted as “including but notlimited to,” the term “having” should be interpreted as “having atleast,” the term “includes” should be interpreted as “includes but isnot limited to,” etc.). It will be further understood by those withinthe art that if a specific number of an introduced claim recitation isintended, such an intent will be explicitly recited in the claim, and inthe absence of such recitation no such intent is present. For example,as an aid to understanding, the following appended claims may containusage of the introductory phrases “at least one” and “one or more” tointroduce claim recitations. However, the use of such phrases should notbe construed to imply that the introduction of a claim recitation by theindefinite articles “a” or “an” limits any particular claim containingsuch introduced claim recitation to inventions containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations. In addition, evenif a specific number of an introduced claim recitation is explicitlyrecited, those skilled in the art will recognize that such recitationshould typically be interpreted to mean at least the recited number(e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that virtually any disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms. For example, the phrase “A or B” will be understood toinclude the possibilities of “A” or “B” or “A and B.”

What is claimed is:
 1. A method at least partially implemented using aprocessing device, the method comprising: receiving at the processingdevice one or more parameters relating to a specific patient, at leastone of the one or more parameters received via an image input directlyfrom an imaging source providing the image input of the specificpatient, the one or more parameters including: a heuristic modelidentifier, the heuristic model identifier identifying a model of acondition requiring a stent; a patient identifier including one or morestent customization parameters comprising at least three-dimensionalanatomical data of at least one blood vessel portion of the specificpatient; and an inventory status parameter providing stent componentinformation and utilizing one or more direct availability information orone or more indirect indications designating an order as an emergencystatus or other parameter indicating an elevated priority relating tothe specific patient; and customizing one or more junctions of a stentex situ in response to the received one or more parameters relating tothe specific patient.
 2. The method of claim 1 in which receiving one ormore parameters relating to a specific patient comprises: receiving acategory identifier as the parameter relating to the specific patient.3. The method of claim 1 in which customizing one or more junctions of astent ex situ in response to the one or more received parametersrelating to the specific patient comprises: receiving a heuristic modelof the one or more junctions of the stent; updating the heuristic modelwith the received parameter relating to the specific patient; andcustomizing the one or more junctions of the stent with the receivedheuristic model of the one or more junctions of the stent updated withthe received parameter relating to the specific patient.
 4. The methodof claim 1 in which receiving one or more parameters relating to aspecific patient comprises: receiving an ingredient indication as one ofthe one or more parameters relating to the specific patient.
 5. A systemcomprising: means for receiving at a computing device one or moreparameters relating to a specific patient, at least one of the one ormore parameters received via an image input directly from an imagingsource providing the image input of the specific patient, the one ormore parameters including: a heuristic model identifier, the heuristicmodel identifier identifying a model of a condition requiring a stent; apatient identifier including one or more stent customization parameterscomprising at least three-dimensional anatomical data of at least oneblood vessel portion of the specific patient; and an inventory statusparameter providing stent component information and utilizing one ormore direct availability information or one or more indirect indicationsdesignating an order as an emergency status or other parameterindicating an elevated priority relating to the specific patient; andmeans for customizing one or more junctions of a stent ex situ inresponse to the one or more parameters relating to the specific patient.6. The system of claim 5 in which the means for receiving one or moreparameters relating to a specific patient comprises: means for receivinga measurement as the parameter relating to the specific patient.
 7. Thesystem of claim 5 in which the means for receiving one or moreparameters relating to a specific patient comprises: means for receivinga category identifier as the parameter relating to the specific patient.8. The system of claim 5 in which the means for customizing one or morejunctions of a stent ex situ in response to the one or more parametersrelating to the specific patient comprises: means for adapting the oneor more junctions of the stent responsive to the one or more parametersrelating to the specific patient.
 9. The system of claim 5 in which themeans for customizing one or more junctions of a stent ex situ inresponse to the one or more parameters relating to the specific patientcomprises: means for customizing the one or more junctions of the stentas an at-least-roughly contemporaneous response to receiving the one ormore parameters relating to the specific patient.
 10. The system ofclaim 5 in which the means for customizing one or more junctions of astent ex situ in response to the one or more parameters relating to thespecific patient comprises: means for forming a seam along at least afirst edge of a sheet element.
 11. The system of claim 5 in which themeans for customizing one or more junctions of a stent ex situ inresponse to the one or more parameters relating to the specific patientcomprises: means for joining a flow occlusion element with aflow-permeable element at a junction location at least partly based onthe one or more parameters relating to the specific patient.
 12. Thesystem of claim 5 in which the means for customizing one or morejunctions of a stent ex situ in response to the one or more parametersrelating to the specific patient comprises: means for engaging a firsttubular element of the stent ex situ with an open end of a secondtubular element of the stent.
 13. The system of claim 5 in which themeans for customizing one or more junctions of a stent ex situ inresponse to the one or more parameters relating to the specific patientcomprises: means for infusing at least one of the one or more junctionswith a therapeutic agent.
 14. The system of claim 5 in which the meansfor customizing one or more junctions of a stent ex situ in response tothe one or more parameters relating to the specific patient comprises:means for configuring one or more pleats of the stent ex situ responsiveto the one or more parameters relating to the specific patient.
 15. Thesystem of claim 5 further comprising: means for generating at least onevariant of the stent in response to the one or more parameters relatingto the specific patient.
 16. The system of claim 5 further comprising:means for engaging an open end of a first tubular element of the stentwith a second tubular element of the stent.
 17. The system of claim 5further comprising: means for displaying a representation of at least aportion of the one or more customized junctions of the stent.
 18. Thesystem of claim 5 in which the means for receiving one or moreparameters relating to a specific patient comprises: means for receivingan ingredient indication as the parameter relating to the specificpatient.
 19. The system of claim 5 in which the means for receiving oneor more parameters relating to a specific patient comprises: means forreceiving a dimension as the parameter relating to the specific patient.20. The system of claim 5 in which the means for customizing one or morejunctions of a stent ex situ in response to the one or more parametersrelating to the specific patient comprises: means for removing materialfrom at least one stent component in the response to the one or moreparameters relating to the specific patient.
 21. The system of claim 5in which the means for customizing one or more junctions of a stent exsitu in response to the one or more parameters relating to the specificpatient comprises: means for configuring a dimension of a layer of thestent ex situ in the response to the one or more parameters relating tothe specific patient.
 22. The system of claim 5 in which the means forcustomizing one or more junctions of a stent ex situ in response to theone or more parameters relating to the specific patient comprises: meansfor configuring a layer of the stent ex situ in the response to the oneor more parameters relating to the specific patient.
 23. The system ofclaim 5 in which the means for customizing one or more junctions of astent ex situ in response to the one or more parameters relating to thespecific patient comprises: means for forming the one or more junctionsof the stent ex situ.
 24. The system of claim 5 in which the means forcustomizing one or more junctions of a stent ex situ in response to theone or more parameters relating to the specific patient comprises: meansfor forming a seam along at least a first edge of a sheet element byjoining a flow occlusion element with a flow-permeable element at ajunction location at least partly based on the one or more parametersrelating to the specific patient as an at-least-roughly contemporaneousresponse to receiving the parameter relating to the specific patient.25. The system of claim 24 further comprising: means for generating atleast one variant of the stent in response to the one or more parametersrelating to the specific patient; means for engaging an open end of afirst tubular element of the stent with a second tubular element of thestent; and means for displaying a representation of at least a portionof the one or more customized junctions of the stent.
 26. The system ofclaim 24 in which the means for receiving one or more parametersrelating to a specific patient comprises: means for receiving aningredient indication as the parameter relating to the specific patient;means for receiving a measurement as the parameter relating to thespecific patient; and means for receiving an identifier of the specificpatient.
 27. The system of claim 24 in which the means for receiving oneor more parameters relating to a specific patient comprises: means forreceiving an identifier of the specific patient; means for receiving acategory identifier as the parameter relating to the specific patient;means for receiving an anatomical model of a portion of the specificpatient, the anatomical model indicating at least a dimension as anotherparameter relating to the specific patient.
 28. The system of claim 5 inwhich the means for customizing one or more junctions of a stent ex situin response to the one or more parameters relating to the specificpatient comprises: means for configuring a dimension of a layer of thestent ex situ by removing material from at least one stent component inthe response to the one or more parameters relating to the specificpatient as an at-least-roughly contemporaneous response to receiving theone or more parameters relating to the specific patient.
 29. The systemof claim 28 further comprising: means for generating at least onevariant of the stent in response to the one or more parameters relatingto the specific patient; means for engaging an open end of a firsttubular element of the stent with a second tubular element of the stent;and means for displaying a representation of at least a portion of theone or more customized junctions of the stent.
 30. The system of claim26 in which the means for receiving one or more parameters relating to aspecific patient comprises: means for receiving an ingredient indicationas the parameter relating to the specific patient; means for receiving ameasurement as the parameter relating to the specific patient; and meansfor receiving an identifier of the specific patient.
 31. The system ofclaim 28 in which the means for receiving one or more parametersrelating to a specific patient comprises: means for receiving anidentifier of the specific patient; and means for receiving a categoryidentifier as the one or more parameters relating to the specificpatient.
 32. The system of claim 5 in which the means for customizingone or more junctions of a stent ex situ in response to the one or moreparameters relating to the specific patient comprises: means forconfiguring a layer of the stent ex situ in the response to the one ormore parameters relating to the specific patient as an at-least-roughlycontemporaneous response to receiving the ne or more parameters relatingto the specific patient; and means for configuring one or more pleats ofthe stent ex situ responsive to the one or more parameters relating tothe specific patient as another at-least-roughly contemporaneousresponse to receiving the one or more parameters relating to thespecific patient.
 33. The system of claim 32 further comprising: meansfor generating at least one variant of the stent in response to the oneor more parameters relating to the specific patient; means for engagingan open end of a first tubular element of the stent with a secondtubular element of the stent; and means for displaying a representationof at least a portion of the one or more customized junctions of thestent.
 34. The system of claim 32 in which the means for receiving oneor more parameters relating to a specific patient comprises: means forreceiving an ingredient indication as the parameter relating to thespecific patient; means for receiving a measurement as the parameterrelating to the specific patient; and means for receiving an identifierof the specific patient.
 35. The system of claim 32 in which the meansfor receiving one or more parameters relating to a specific patientcomprises: means for receiving an identifier of the specific patient;and means for receiving a category identifier as the one or moreparameters relating to the specific patient.
 36. The system of claim 5in which the means for customizing one or more junctions of a stent exsitu in response to the one or more parameters relating to the specificpatient comprises: means for infusing at least one of the one or morejunctions with a therapeutic agent as an at-least-roughlycontemporaneous response to receiving the one or more parametersrelating to the specific patient; and means for forming the one or morejunctions of the stent by engaging a first tubular element of the stentex situ with an open end of a second tubular element of the stent asanother at-least-roughly contemporaneous response to receiving the oneor more parameters relating to the specific patient.
 37. The system ofclaim 36 further comprising: means for generating at least one variantof the stent in response to the one or more parameters relating to thespecific patient; means for engaging an open end of a first tubularelement of the stent with a second tubular element of the stent; andmeans for displaying a representation of at least a portion of the oneor more customized junctions of the stent.
 38. The system of claim 36 inwhich the means for receiving one or more parameters relating to aspecific patient comprises: means for receiving an ingredient indicationas the parameter relating to the specific patient; means for receiving ameasurement as the parameter relating to the specific patient; and meansfor receiving an identifier of the specific patient.
 39. The system ofclaim 36 in which the means for receiving one or more parametersrelating to a specific patient comprises: means for receiving anidentifier of the specific patient; and means for receiving a categoryidentifier as the one or more parameters relating to the specificpatient.